Laparoscopic Versus Open Colorectal Surgery in the Emergency Setting: A Systematic Review and Meta-analysis

Anne-Loes K Warps; Emma S Zwanenburg; Jan Willem T Dekker; Rob A E M Tollenaar; Willem A Bemelman; Roel Hompes; Pieter J Tanis; Elisabeth J de Groof

doi:10.1097/AS9.0000000000000097

Laparoscopic Versus Open Colorectal Surgery in the Emergency Setting: A Systematic Review and Meta-analysis

Ann Surg Open. 2021 Sep 14;2(3):e097. doi: 10.1097/AS9.0000000000000097. eCollection 2021 Sep.

Authors

Anne-Loes K Warps^{1

2

3}, Emma S Zwanenburg¹, Jan Willem T Dekker⁴, Rob A E M Tollenaar^{2

3}, Willem A Bemelman¹, Roel Hompes¹, Pieter J Tanis⁵, Elisabeth J de Groof¹

Affiliations

¹ From the Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef, Amsterdam, The Netherlands.
² Department of Surgery, Leiden University Medical Center, Albinusdreef, Leiden, The Netherlands.
³ Dutch ColoRectal Audit (DCRA), Dutch Institute for Clinical Auditing, Rijnsburgerweg, Leiden, The Netherlands.
⁴ Department of Surgery, Reinier de Graaf Groep, Reinier de Graafweg, Delft, The Netherlands.
⁵ Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, de Boelelaan, Amsterdam, The Netherlands.

Abstract

Objective: This systematic review and meta-analysis aimed to compare published outcomes of patients undergoing laparoscopic versus open emergency colorectal surgery, with mortality as primary outcome.

Background: In contrast to the elective setting, the value of laparoscopic emergency colorectal surgery remains unclear.

Methods: PubMed, Embase, the Cochrane Library, and CINAHL were searched until January 6, 2021. Only comparative studies were included. Meta-analyses were performed using a random-effect model. The Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale were used for quality assessment.

Results: Overall, 28 observational studies and 1 randomized controlled trial were included, comprising 7865 laparoscopy patients and 55,862 open surgery patients. Quality assessment revealed 'good quality' in 16 of 28 observational studies, and low to intermediate risk of bias for the randomized trial. Laparoscopy was associated with significantly lower postoperative mortality compared to open surgery (odds ratio [OR] 0.44; 95% confidence interval [CI], 0.35-0.54). Laparoscopy resulted in significantly less postoperative overall morbidity (OR, 0.53; 95% CI, 0.43-0.65), wound infection (OR, 0.63; 95% CI, 0.45-0.88), wound dehiscence (OR, 0.37; 95% CI, 0.18-0.77), ileus (OR, 0.68; 95% CI 0.51-0.91), pulmonary (OR, 0.43; 95% CI, 0.24-0.78) and cardiac complications (OR, 0.56; 95% CI, 0.35-0.90), and shorter length of stay. No meta-analyses were performed for long-term outcomes due to scarcity of data.

Conclusions: The systematic review and meta-analysis suggest a benefit of laparoscopy for emergency colorectal surgery, with a lower risk of postoperative mortality and morbidity. However, the almost exclusive use of retrospective observational study designs with inherent biases should be taken into account.